Fentanyl Iontophoretic Transdermal System

INTRODUCTION

Indications

Short-term management of acute postoperative pain in hospitalized patients.

Action

Binds to opiate receptors in the CNS, altering the response to and perception of pain. Therapeutic Effects: Decreased pain.

Adverse Reactions/Side Effects

CNS: headache, anxiety, dizziness, insomnia, somnolence. Resp: RESPIRATORY DEPRESSION, hypoxia, pharyngitis. CV: bradycardia, hypertension, hypotension, tachycardia. GI: nausea, vomiting, abdominal pain, constipation, dyspepsia, flatulence, ileus. GU: urinary retention. Derm: application site reactions, itching. F and E: hypokalemia. Hemat: anemia. MS: back pain. Neuro: hypertonia. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess symptoms of respiratory depression, including decreased respiratory rate, confusion, bluish color of the skin and mucous membranes (cyanosis), and difficult, labored breathing (dyspnea). Monitor pulse oximetry and perform pulmonary function tests (See Appendix I) to quantify suspected changes in ventilation and respiratory function. Excessive respiratory depression requires emergency care.

• Be alert for excessive sedation or changes in mood and behavior (anxiety, confusion). Notify physician or nurse immediately if patient is unconscious or extremely difficult to arouse.

• Use appropriate pain scales (visual analogue scales, others) to document whether this drug is successful in helping manage the patient's pain.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report rapid or slow heart rate (tachycardia or bradycardia, respectively), or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, pallor, and bruising. Notify physician if these signs occur.

• Monitor any muscle weakness, aches, back pain, cramps, or increased muscle tone that might indicate low potassium levels (hypokalemia). Report suspicious neuromuscular symptoms to the physician.

• Monitor application site for pain, swelling, and irritation. Report prolonged or excessive application-site reactions to the physician.

Interventions

• Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and help wean patient off opioid analgesics as soon as possible.

• Avoid contact with the transdermal application site, and do not apply massage or physical agents (heat, cold, electrotherapeutic modalities) at or near the application site.

• Because of the risk of respiratory depression and arrhythmias, use caution during aerobic exercise ...